Wednesday, August 16, 2006

How I Love These Teachable Moments

Back when I taught high-school English I gave the obligatory lessons on the difference between denotation and connotation: a word’s dictionary definition versus what it actually implies when used in everyday contexts.

Thin and skinny mean basically the same thing — but which word are you more likely to hear when someone’s being insulting? What about fat versus overweight? Before long, world events and the Bush administration provided me plenty of “teachable moments,” since America and her friends have “governments” while our enemies lean more toward “regimes,” even though the two definitions in our school’s dictionaries were nearly word-for-word identical.

The family of a Virginia teenager who has refused conventional medical treatment for cancer reached a settlement yesterday with state officials, agreeing that he will be seen by a new oncologist while continuing his alternative therapy.

The compromise means that Starchild Abraham Cherrix, 16, will not have to undergo chemotherapy against his will, as a judge had ordered. Officials in Accomack County on Virginia's Eastern Shore had accused his parents of medical neglect for allowing him to seek alternative treatment from a clinic in Mexico.

The story goes on to talk about how the case has received a great deal of media attention, not just from a parents’-rights angle, but also to question how much control a 16-year-old should have over his own body. Will you strap him down and inject him with the chemicals against his will? (The story doesn't ask that; I did.)

Next, some family background information:

The family lives in Chincoteague, a resort-like community known for holding a wild pony swim each year. Jay Cherrix runs a canoe and kayak rental business and home-schools his five children. He has a history of anti-government activism: Several years ago, he led residents in opposition to what they thought was a plan to bring commercial development to Assateague Island, the federally protected 37-mile beach near his shop.

“Led residents in opposition.” What does this mean — did he circulate a petition? Speak at city council meetings? Lead a picket line? I don’t know, but what he did, combined with fighting back when social services tried to charge him with neglect when he wouldn’t force his 16-year-old to undertake chemo, is enough to qualify him as an “anti-government activist.”

Another teachable moment! Remember all those politicians who have railed against judicial activists in the past? Gee, class, I wonder if “activist” has any sort of connotation? Let’s type the word into Google News and see what comes up:

Judicial activists are bad enough to make members of government notice, while other types of activists wind up in prison or at least in police custody. Now, class: what connotations, if any, are there when a person who recently won a court battle fighting charges of medical neglect is said to have a (one-time, several years ago) “history of anti-government activism?”

By the way: it’s not just words that have connotations. Sometimes entire facts do, when presented in a certain order. Check this out:

An initial round of chemotherapy ravaged Abraham Cherrix, he and his parents have said, reducing his 6-foot frame to 122 pounds and causing his hair to fall out. After the therapy shrank his tumors but did not eliminate all signs of the disease, an oncologist at the Norfolk hospital recommended radiation and more chemotherapy.

Instead, Cherrix began an alternative treatment he had researched in Mexico consisting of herbal supplements and an organic diet free of processed sugar. The treatment was initiated by Harry Hoxsey, a former Texas cancer clinic operator who was accused by the Food and Drug Administration of peddling worthless medicine -- and who later died of cancer.

Wow. Cherrix wants to try a treatment whose own inventor died of cancer. That sounds pretty damning. Now consider what the National Cancer Institute says about the survival rate for children or adolescents with Hodgkin’s disease who undergo one unsuccessful bout with chemotherapy and then try it again:

In one study from the German Pediatric Oncology Group (GPOH), patients with an early relapse (defined as occurring between 3 and 12 months from the end of therapy) had a 10-year event-free survival (EFS) of 55% and a 5-year overallsurvival (OS) of 78%.

About 45 percent of Hodgkin’s chemotherapy patients in Cherrix’s situation wind up dying of cancer anyway. So, class: is there any connotation when a writer mentions Harry Hoxsey’s death but says nothing about the survival rates Cherrix would face with chemotherapy?

And for extra credit: discuss the overall connotations contained in the story. Do you think the writer agrees or disagrees with Cherrix's parents' decision? Explain.

A few years back I probably would have declared this as child abuse. Now I'm at the point where I firmly feel that if you fervently and completely reject science for holistic cures, you really need to die.

Jeff, if the kid wanted chemotherapy but his parents refused, I'd fully agree with you. Or if this kid were six, rather than sixteen. But seriously--how do you force a 16-year-old to undergo painful medical treatments he simply doesn't want? The initial court ruling would have forced him to get the chemo--should he have strapped down while the chemicals were injected? Locked in a cell and told "You can come out when your therapy is done?"

My favorite part of the article is the dramatic deflation of using the simple declarative sentence "Harry Hoxsey died of cancer" after the paragraph discussing the treatment. The order of the facts plus the grammatical construction of that paragraph is truly amazing.

I agree that the Hoxsey method is quackery, and, in fact, a friend of mine died of melanoma after taking that particular treatment. (She was 33, and had a relapse after first being diagnosed in her early 20's.) Still, in Jennie's case as in this boy's case, once the first therapy failed there just isn't that much hope. THe author owes it to the readers to include the dismal survival statistics for people with this particular disease. It might also help to mention the nontrivial side effects of chemotherapy and radiation, including the fact that the process of delivering chemo drugs involves injection using really big needles. (I believe she did mention hair loss, which perversely only made the family look vain.) The kid and his parents made a decision that his last days shouldn't be spent in pain from his medicine as much as from his disease.

While I'm at it, why mention that Pops has a history of activism at all? What does this add to the story other than a chance for the writer to portray the family as cranks? Besides, I'm pretty sure that the development on Assategue was opposed by almost every mainline conservation group on the planet anyway. Probably by every adult who read "Misty of Chincoteague" and "Stormy, Misty's Foal" as a child. (Incidentally, why didn't she mention those books which did more to make those islands famous than anything else?) The writer portrayed a man with a perfectly ordinary environmentalist position as though he were the Unabomer.

Now, I have to admit that my evaluation of this case in favor of the kid and his parents depends largely on three factors: his age and apparent maturity, his poor prognosis even with conventional treatment, and, especially, the fact that he did one unsuccessful round of chemo already. Make him a six-year-old with something more easily treatable by conventional medicine who hasn't had the conventional treatment, and my opinion completely changes. Still, none of these cases are easy, and I really feel for the judge here.

My feelings agree with Jeff: if this stupid hippie wants to keep taking herbs because he doesn't care about a 55% chance of survival and they make him feel better, he has it coming if he dies. I mean, okay, it's basically a coin flip if the kid lives or dies with further treatment...but there's exactly zero that he lives with this herbal crap. If he's so adamant about killing himself, fine.

But, I also detest that a 16-year-old has the exact same legal standing as an infant. The kid is old enough to know the consequences of his actions and I don't think there's any legitimate interest in trying to force him to make better choices.

I'm not convinced that describing the father as an "activist" is necessarily a pejorative. If you sympathize with the father's position in this case, you could look at it and say "Wow, at least this family has experience challenging the authorities. If it were me, I probably wouldn't know how to defend my family's right to make difficult decisions privately."

As to the merits, the way I read the story it sounded like the court-appointed doctor can go ahead with radiation therapy at some point. Leaving aside matters of principle, as far as outcomes I'd say that's a rather deft handling: Turn this over to a doctor who has conventional medical credentials, but also more openness to alternative therapies, and hope that he can find a solution. The family and patient might be more receptive to traditional medical advice if it comes from somebody who has sympathy for their preferences.

...but there's exactly zero that he lives with this herbal crap. If he's so adamant about killing himself, fine.

Perhaps. Then again, there's exactly zero chance that any of those posting here, with the possible exception of Jennifer, will survive either. Life is a terminal condition. Perhaps that's how he wants to spend the remaining time on his ticket.

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About Me

Jennifer Abel is an American writer who began her career in print media three minutes before the Internet killed the industry. After starting at a small Connecticut daily she moved to the Hartford Advocate, an alt-weekly where her journalistic coups included infiltrating a Furries convention and working on a phone sex line (which fired her six hours later). Since then she’s written for, or been reprinted in, dozens of print and web outlets, including Playboy, the Guardian, Salon, AlterNet, Mashable, the Daily Dot and pretty much every website with the words "cannabis" or "legalize it" in the title. Once, when she was young and naïve and needed the money, she unwittingly edited SEO copy for a spammer. However, in light of the spambot comments she’s deleted from her own blogs since then, she figures she’s more than repaid that particular karmic debt. Jennifer is currently looking for professional, non-spam writing jobs; interested editors are enthusiastically invited to e-mail her.